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Open Access Publications from the University of California

Scholarly Works (21 results)

  • Thesis
  • Peer Reviewed
UC San Francisco Electronic Theses and Dissertations (1985)

    Cover page: Social organization and health services for preschool children on Niue Island, Western Polynesia
    • Thesis
    • Peer Reviewed
    UC San Francisco Electronic Theses and Dissertations (2012)

    The emergence of HIV/AIDS in the 1980s prompted a dramatic shift in the way public health professionals around the world addressed the issue of drug use. For the first time, interventions were now developed to specifically address the transmission of blood-borne diseases among drug users. Some of the most prominent interventions were those based on harm reduction, a public health model that places emphasis on reducing the negative consequences of drug use rather than on eliminating drug use or ensuring abstinence. This dissertation charts the adoption and promotion of harm reduction in Argentina, a country with one of the highest rates of drug use-related HIV prevalence in all of Latin America. Tracing how harm reduction has traveled to and within Argentina since the mid-1990s, I explore how local non-governmental organizations and select government agencies utilize harm reduction to ground their work among drug users in Buenos Aires and Rosario, the metropolitan areas with the country's greatest concentration of drug users. I examine ethnographically how Argentine harm reductionists approach drug use and drug-related harm from a joint public health and rights perspective, a dual focus that uniquely influences their implementation of community-based interventions as well as their promotion of drug user rights and citizenship. By analyzing such projects, this dissertation shows that 1) harm reduction strategies, programs, and policies which set out as a uniform set of practices change when they travel and 2) that the major change in Argentina is that "the social" becomes an important site for intervention. In other words, it is not just that social context changes harm reduction, but that harm reduction in Argentina is all about changing the social. In the process, harm reduction renders drug use and drug users thinkable in new, productive ways. This dissertation is based on sixteen months of ethnographic research conducted in Argentina, including two months of preliminary research in the summer of 2006 and fourteen months of full-time research from September 2007 to October 2008. Research methods included participant observation, semi-structured and structured interviews, archival data collection, and textual analysis.

      Cover page: Out of Harm's Way: The Politics and Practice of Harm Reduction in Argentina
      • Article
      • Peer Reviewed
      UC San Francisco Previously Published Works (2008)

      Background

      Latino children experience a higher prevalence of caries than do children in any other racial/ethnic group in the US. This paper examines the intersections among four societal sectors or contexts of care which contribute to oral health disparities for low-income, preschool Latino1 children in rural California.

      Methods

      Findings are reported from an ethnographic investigation, conducted in 2005-2006, of family, community, professional/dental and policy/regulatory sectors or contexts of care that play central roles in creating or sustaining low income, rural children's poor oral health status. The study community of around 9,000 people, predominantly of Mexican-American origin, was located in California's agricultural Central Valley. Observations in homes, community facilities, and dental offices within the region were supplemented by in-depth interviews with 30 key informants (such as dental professionals, health educators, child welfare agents, clinic administrators and regulatory agents) and 47 primary caregivers (mothers) of children at least one of whom was under 6 years of age.

      Results

      Caregivers did not always recognize visible signs of caries among their children, nor respond quickly unless children also complained of pain. Fluctuating seasonal eligibility for public health insurance intersected with limited community infrastructure and civic amenities, including lack of public transportation, to create difficulties in access to care. The non-fluoridated municipal water supply is not widely consumed because of fears about pesticide pollution. If the dentist brought children into the clinic for multiple visits, this caused the accompanying parent hardship and occasionally resulted in the loss of his or her job. Few general dentists had received specific training in how to handle young patients. Children's dental fear and poor provider-parent communication were exacerbated by a scarcity of dentists willing to serve rural low-income populations. Stringent state fiscal reimbursement policies further complicated the situation.

      Conclusion

      Several societal sectors or contexts of care significantly intersected to produce or sustain poor oral health care for children. Parental beliefs and practices, leading for example to delay in seeking care, were compounded by lack of key community or economic resources, and the organization and delivery of professional dental services. In the context of state-mandated policies and procedures, these all worked to militate against children receiving timely care that would considerably reduce oral health disparities among this highly disadvantaged population.
        Cover page: An ethnographic study of Latino preschool children's oral health in rural California: Intersections among family, community, provider and regulatory sectors
        • Article
        • Peer Reviewed
        UC San Francisco Previously Published Works (2008)

        Background

        The purpose of this study was to assess information available in the dental literature on oral health-related cultural beliefs. In the US, as elsewhere, many racial/ethnic minority groups shoulder a disproportionate burden of oral disease. Cultural beliefs, values and practices are often implicated as causes of oral health disparities, yet little is known about the breadth or adequacy of literature about cultural issues that could support these assertions. Hence, this rigorous assessment was conducted of work published in English on cultural beliefs and values in relation to oral health status and dental practice. Four racial/ethnic groups in the US (African-American, Chinese, Filipino and Hispanic/Latino) were chosen as exemplar populations.

        Methods

        The dental literature published in English for the period 1980-2006 noted in the electronic database PUBMED was searched, using keywords and MeSH headings in different combinations for each racial/ethnic group to identify eligible articles. To be eligible the title and abstract when available had to describe the oral health-related cultural knowledge or orientation of the populations studied.

        Results

        Overall, the majority of the literature on racial/ethnic groups was epidemiologic in nature, mainly demonstrating disparities in oral health rather than the oral beliefs or practices of these groups. A total of 60 relevant articles were found: 16 for African-American, 30 for Chinese, 2 for Filipino and 12 for Hispanic/Latino populations. Data on beliefs and practices from these studies has been abstracted, compiled and assessed. Few research-based studies were located. Articles lacked adequate identification of groups studied, used limited methods and had poor conceptual base.

        Conclusion

        The scant information available from the published dental and medical literature provides at best a rudimentary framework of oral health related ideas and beliefs for specific populations.
          Cover page: Oral health-related cultural beliefs for four racial/ethnic groups: Assessment of the literature
          • Article
          • Peer Reviewed
          UC San Francisco Previously Published Works (2015)
          The experience of depression is diverse based on social locations and context. A sociological perspective building on masculinity, illness work, and the self provides a useful theoretical framework to understand how older men negotiate emotional suffering. This article examines older men's accounts of their depression experience from a social constructionist approach. This analysis is based on data from 77 in-depth interviews with depressed older men who participated in a larger mixed-method study, the Men's Health and Aging Study (MeHAS). We show how older men construct depression accounts in which they integrate biological and social factors associated with feeling a loss of control. This is experienced as a shamed masculine self given their inability to perform manhood acts, which leads them to severe social bonds. Men's accounts also shed light on how they resist the shaming of the masculine self by deploying two primary strategies: acting overtly masculine through aggressive behavior and by retracting from social interactions that may lead to feelings of shame. These strategies appear futile and they are only partially able to embrace alternative masculine values in line with roles as grandparents and older, wiser men. Depression in older men is characterized by an ongoing negotiation of limited statuses and roles given dominant conceptions of masculinity.
            Cover page: Shards of sorrow: Older men's accounts of their depression experience
            • Article
            • Peer Reviewed
            UC San Francisco Previously Published Works (2013)

            Objectives

            The aim of the present study was to investigate second-year medical students' understanding of quality of life associated with childhood inflammatory bowel disease (IBD).

            Methods

            A cross-sectional study in a major teaching institution in San Francisco was carried out. A questionnaire was administered following an hour-long gastroenterology lecture, which featured 2 young patients with pediatric-onset IBD who addressed everyday life with the disease. Analyses of numerate responses to the questionnaire were paired with a content and thematic analysis of audiotape recordings of the patients' commentaries.

            Results

            Medical students' responses to the patient interviews were extremely positive. Medical students gained a new awareness of the psychosocial complexities associated with living with a pediatric chronic illness and a new way of thinking about the meaning of "healthy." Despite listening to 2 healthy young patients, however, the medical students still conceptualized pediatric IBD in mostly, although not exclusively, negative terms.

            Conclusions

            Medical students' perceptions of pediatric IBD improved as a result of listening to the patient interviews. Although this teaching modality effectively introduced students to a complex condition, it did not overcome their unfavorable impression of the effect of IBD on children's lives. The symptoms associated with IBD have stigma attached to them, and these stereotypes influence how medical students perceive those living with this chronic illness. More research and training in this area is necessary.
              Cover page: Medical Students’ Conceptualizations of Quality of Life Associated With Children With IBD
              • Article
              • Peer Reviewed
              UC San Francisco Previously Published Works (2018)

              Purpose

              Children's health is influenced by the context in which they live. We provide a descriptive essay on the status of children in rural America to highlight features of the rural environment that may affect health.

              Description

              We compiled information concerning components of the rural environment that may contribute to health outcomes. Areas addressed include the economic characteristics, provider availability, uniquely rural health risks, health services use, and health outcomes among rural children.

              Assessment

              Nearly 12 million children live in the rural United States. Rural counties are economically disadvantaged, leading to higher rates of poverty among rural versus urban children. Rural and urban children are approximately equally likely to be insured, but Medicaid insures a higher proportion of children in rural areas. While generally similar in health, rural children are more likely to be overweight or obese than urban children. Rural parents are less likely to report that their children received preventive medical or oral health visits than urban parents. Rural children are more likely to die than their urban peers, largely due to unintentional injury.

              Conclusion

              Improving rural children's health will require both increased public health surveillance and research that creates solutions appropriate for rural environments, where health care professionals may be in short supply. Most importantly, solutions must be multisectoral, engaging education, economic development, and other community perspectives as well as health care.
                Cover page: Current State of Child Health in Rural America: How Context Shapes Children's Health
                • Thesis
                • Peer Reviewed
                UC San Francisco Electronic Theses and Dissertations (2016)

                Tooth decay is the most prevalent chronic infectious condition experienced by children in the United States, disproportionately affecting children in low-income Latino families. A theory-based, promotora-led curriculum, Contra Caries Oral Health Education Program (CCOHEP), was developed to improve low-income Spanish-speaking parents’ oral hygiene behaviors for their young children. The objective of this dissertation was to evaluate CCOHEP for acceptability, feasibility, effectiveness, and the utility of Social Cognitive Theory constructs for improving parental knowledge and behavior around their children’s oral health. Acceptability was assessed through qualitative analysis of twelve Spanish-language focus groups (n=51). Feasibility was assessed through implementation data including attendance and attrition. Effectiveness and theoretical constructs were assessed through a questionnaire verbally administered before, immediately after, and 3 months after attendance at CCOHEP. And within-person change was measured between timepoints. Overall, 105 caregivers participated in CCOHEP (n= 105 pretest, n=95 posttest, n=79 second posttest). At baseline, all parents self-reported doing at least one aspect of toothbrushing correctly, but only 13% reported performing all five aspects according to professional guidelines. At posttest, 44% of parents reported completing all aspects of tooth brushing according to professional guidelines (p<.001). Knowledge was high at baseline (mean 12.8 of 16), but 6 knowledge items improved significantly between pretest and posttest. Social Cognitive Theory constructs of outcome expectations and situation were found to be significantly associated with a caregiver brushing their child’s teeth twice a day at baseline and with improvements in that behavior after CCOHEP. Self-efficacy to brush child’s teeth with fluoridated toothpaste, outcome expectation, and environment were all significantly associated with caregivers brushing child’s teeth with fluoridated toothpaste at baseline and with improvements in that behavior after CCOHEP. Eight of the 10 measured SCT constructs improved after attendance at CCOHEP, and were maintained or further improved 3 months after. CCOHEP was acceptable to and improved low-income Spanish-speaking parents’ oral hygiene knowledge and self-reported behaviors for their young children, and change was sustained 3 months after the end of the intervention. Five social cognitive theory constructs were associated with baseline behaviors and improvements in behavior. Further study of CCOHEP is warranted.

                  Cover page: Parental preventive behaviors and oral health in Latino children
                  • Article
                  • Peer Reviewed
                  UC San Francisco Previously Published Works (2016)
                    • Article
                    • Peer Reviewed
                    UC San Francisco Previously Published Works (2015)

                    Objective

                    Depression is associated with poor quality of life, higher healthcare costs, and suicide. Older, especially minority, men suffer high rates of depression under-treatment. Illness attributes may influence depression under-treatment by shaping help-seeking and physician recognition in older and minority men. Improved understanding of depression attributes may help to close gaps in care for older men. The study aims are to describe the range and most frequent attributes of depression in a diverse sample of older men and to describe ethnic similarities and differences in depression attributes between white non-Hispanic and Mexican-origin older men.

                    Methods

                    In this qualitative study of white non-Hispanic and Mexican-origin older men who were recruited from outpatient primary care clinics in central California, 77 (47 white non-Hispanic and 30 Mexican-origin) men aged 60 and older who were identified as depressed and/or receiving depression treatment in the past year completed in-depth interviews covering their experiences of depression. Transcribed interviews were analyzed per established descriptive qualitative techniques.

                    Results

                    Twenty-one depression attributes were identified and 9 were present in at least 17% of the interviews. Men often attributed their depression to stressors such as grief/loss and spousal conflicts, feelings of moral failure, and poor health. Although there were similarities in depression attributes between the groups, we found several differences in the frequency of certain attributes.

                    Conclusion

                    Similarities and differences in depression attributes between Mexican-origin and white non-Hispanic older men suggest the confluence of various sociocultural factors. Awareness of the variety of ways that older men understand depression can help clinicians identify and engage them in depression treatment.
                      Cover page: Depression Attributes Among White Non-Hispanic and Mexican-Origin Older Men
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